Rheumatic heart disease neglected

Heart disease triggered by rheumatic fever is being widely neglected by health care services worldwide, a new report warns.

In many countries rheumatic heart disease (RHD) is the most common form of heart disease among children. It causes about 1.4 million deaths annually, particularly in low and middle-income countries.

As it is triggered by rheumatic fever, RHD can be prevented by treating the streptococcal throat infection, which precedes rheumatic fever, with antibiotics. In addition, oral anti-clotting drugs such as warfarin can benefit RHD patients by helping avoid a stroke.

But findings from the new Global Rheumatic Heart Disease Registry, published today (26 November) in the European Heart Journal, raise many concerns. The current study looked at 3,343 RHD patients at 25 hospitals in 12 African countries, India and Yemen from January 2010 to November 2012.

This showed that only 55% of RHD patients took penicillin or another antibiotic, and less than third of patients with heart problems were receiving the anti-coagulants at the right dose. Among female patients, 20% of pregnant women were given warfarin despite its known dangers to the foetus.

"Our findings reflect the utter neglect of rheumatic heart disease in affected countries," said researcher Professor Bongani Mayosi, of the University of Cape Town, South Africa.

"Most of the interventions that are not applied, such as lack of penicillin use in half of the cases are available and cheap in the countries concerned, and their application will provide the greatest benefit."

Professor Mayosi added: "At present, the primary healthcare systems are not prioritising these simple, but effective measures. Rheumatic heart disease is a disease of poverty, neglected by the health ministries in affected countries and by the international community in general."

Zuhlke, L. et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the Remedy study). European Heart Journal 26 November 2014; doi:10.1093/eurheartj/ehu449